Association of Urine Albumin Excretion With Incident Heart Failure Hospitalization in Community-Dwelling Adults

Abstract

Objectives-To examine the association of urinary albumin excretion with incident heart failure (HF) hospitalization. Background-Excess urinary albumin excretion is more strongly associated with incident stroke and coronary heart disease risk in black than in white individuals. Whether similar associations extend to HF is unclear. Methods-In 24,433 Reasons for Geographic and Racial Differences in Stroke (REGARDS) study participants free of suspected HF at baseline, we examined the associations of urinary albumin to creatinine ratio (ACR) with expert-adjudicated incident hospitalization for HF overall, and stratified by race and HF subtype (preserved vs. reduced ejection fraction). Models were adjusted for socio-demographic, clinical and laboratory variables including estimated glomerular filtration rate, and multiple imputation was used to account for missing covariate data. Results-After a median 9.2 years of follow-up, 881 incident HF events (332 preserved ejection fraction, 447 reduced ejection fraction, 102 unspecified) were observed. Compared to the lowest ACR category (< 10 mg/g), the risk of incident HF increased with increasing ACR categories

Prevention of heart failure events with intensive versus standard blood pressure lowering across the spectrum of kidney function and albuminuria: a SPRINT substudy

“…6,7 Indeed, the Systolic Blood Pressure Intervention Trial (SPRINT) showed that intensive blood pressure control reduced the risk of HF among middle-aged and older adults at high risk for cardiovascular events. 8 Although low estimated glomerular filtration rate (eGFR) and high urine albumin-to-creatinine ratio (UACR) appear to identify patients at very high risk for incident HF, [9][10][11][12][13] it is uncertain whether intensive blood pressure control reduces the risk of HF consistently across the spectrum of kidney function. In this post hoc analysis of SPRINT, we investigate whether eGFR and UACR independently predicted HF events and determine the effects of intensive blood pressure control on HF risk across the eGFR and UACR spectrum.…”

Association of urine albumin‐to‐creatinine ratio with subclinical systolic dysfunction in hypertensive patients but not normotensive subjects: Danyang study

“…This pattern was consistent when excluding patients with known coronary heart disease or LVH or diabetes and was also observed in multivariable analyses. As higher UACR levels may be predictive of incident HF, 22 especially for HFpEF, 23 in addition to and independent of traditional cardiovascular risk factors and estimated glomerular filtration rate, our finding therefore could have important clinical implications for HF prevention, especially for HFpEF prevention by reducing UACR and by treating the amendable comorbidities, such as hypertension.…”

Biomarkers in Heart Failure with Preserved Ejection Fraction

“…141 Urinary albumin-to-creatinine ratio >300 mg/g has been associated with a 4-to 5-fold increased risk of incident HF hospitalisation (Table 3). 142 In established HFpEF, UAE is a powerful and independent predictor of both cardiovascular and non-cardiovascular death (Table 3), 143 in each stratum of eGFR. 141 Resistance to leptin is associated with diastolic dysfunction and promotion of sodium retention 118,119 Adiponectin Increases insulin sensitivity and b-oxidation Marker of catabolic state and disease progression Not associated with death or HF admission 120 Resistin Increases insulin resistance and inflammation Not associated with prognosis.…”

“…116 Albuminuria Marker of kidney damage, systemic inflammation, and endothelial dysfunction Associated with incident HF hospitalisation. 142 Independent associated for both cardiovascular and non-cardiovascular death. 143 KIM-1 Marker of renal injury Independently associated with incident HF hospitalisation.…”